Lighting a candle for the living

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Ten days after the death of Mao Zedong, in September 1976, Dr Michael Phillips, a young Canadian, arrived at Beijing Language and Culture University to study Putonghua. A month later he marched with other students from the capital's Haidian district to Tiananmen Square.

'Down with the Gang of Four! Long live Hua Guofeng,' the crowd chanted. He could not speak a word of Chinese, but other foreign students who had been studying it for longer explained what the chants meant.

Thirty-five years later, and now fluent in Putonghua, Phillips is one of the mainland's top psychiatrists and has played a key role in suicide prevention efforts that have helped save the lives of an estimated 2 million mainlanders.

Phillips, better known on the mainland as Fei Lipeng, is based in Shanghai, and executive director of the WHO Collaborating Centre for Research and Training in Suicide Prevention at Beijing Huilongguan Hospital. He is also treasurer and China representative at the International Association for Suicide Prevention.

Nine years ago, Phillips and two mainland colleagues published an article in the medical journal The Lancet that rocked the psychiatric world, at home and abroad. Based on mortality data for 1995-99 provided by the Ministry of Health, 'Suicide rates in China, 1995-99' estimated that the mean annual suicide rate was 23 per 100,000, with 287,000 suicides a year, making the mainland's suicide rate one of the highest in the world.

The article said that the rate among women was 25 per cent higher than in men, mainly because of the large number of suicides among young women in rural areas. This was in sharp contrast to Western countries, where three times more men kill themselves, compared to women. The mainland's suicide rate in rural areas was three times higher than in urban centres, with most taking their lives by drinking pesticide.

Sitting in his office at the Shanghai Mental Health Centre, Phillips, 62, says the number of suicides has been dropping steadily for the past two decades and now stands at fewer than195,000 a year.

'There are about 100,000 suicide deaths less every year compared with 20 years ago, and in total two million people have been saved. It's hard to determine my role in this, but I would say I definitely made a contribution,' he says.

'It's impossible to take part in such a huge project in other countries. That's the attraction of my job.'

Phillips earned his medical degree from McMaster University in Canada in 1974 and then worked in Auckland for two years. He was thinking of working in Africa next, but by chance he was given the opportunity to study Putonghua on the mainland as an exchange fellow in 1976.

After studying Putonghua for two years in Beijing and Nanjing, Phillips discovered that he could 'do things in China' and decided to focus on public health and psychiatry.

'Mao Zedong's great contribution in medicine was that he advocated developing the healthcare system in rural areas,' Phillips says. 'With so-called barefoot doctors in villages, the public health level in China's rural regions was better than other countries at a similar stage of economic development.

'I wanted to learn about those public health measures and thought they could be applied in other places in the future.'

Phillips studied psychiatry, epidemiology and anthropology at the University of Washington in the United States from 1980 to 1985, before spending two years as a visiting scholar at Hunan Medical University in Changsha, Hunan .

In 1987, again by chance, he was offered a job at the Mental Illness Hospital in Shashi, a rural backwater in Hubei. He stayed there for seven years, training psychiatrists from across the country and researching schizophrenia. For two years he was in charge of 90 beds.

Phillips says the language barrier was a challenge, admitting that he is not a naturally talented linguist. 'I grew up in Montreal where there are two languages. My French score was often 60 [out of 100].' He had to work hard to understand what his patients and their relatives said, in various dialects, instead of seeking help from interpreters.

But that problem largely vanished when Phillips moved to Beijing Huilongguan Hospital in 1994, and he realised that he could understand what everyone was talking about on the city's buses.

Last year, he resigned from the hospital, while retaining his position at the WHO collaborating centre, and started to work at the Shanghai Mental Health Centre.

'Nobody can predict whether the suicide rate goes up or down, and there are just many, many factors that work together to result in the suicide rate,' he says. 'What are the major ones? My guess is economic improvement ... there are a lot fewer people living in poverty right now.'

There are still some differences between China and Western countries. Drinking pesticide remains the most common method of committing suicide on the mainland, and the suicide rate is now equal for men and women, with the rate in rural areas now double that in urban centres. In addition, most Western doctors would not believe, Phillips says, that one third of mainlanders who kill themselves and two thirds of those who attempt suicide, do not have a diagnosable mental illness. In the West, 90 per cent in both categories have active mental problems.

Phillips keeps in touch with developments in the West and spends some time in the US each year as a visiting professor of psychiatry and behavioural sciences at Emory University in Atlanta, and professor of clinical psychiatry and epidemiology at Columbia University in New York.

For 10 years, he has been unsuccessfully trying to promote a national suicide prevention plan to the central government.

It is designed to engage multiple institutions, including the education, health, public security and agriculture authorities, and to be implemented in several steps.

Phillips says one essential step is to carry out long-term 'panel studies' to make teenagers 'more psychologically resilient'. They would be divided into small groups to interact and learn how to deal with stresses. Other steps include removing the stigma from patients with mental problems, providing a high-quality mental health service, assessing those who are saved from suicide attempts, improving social networks, tightening up on access to pesticides and establishing associations for the families of those who have killed themselves.

Phillips says putting the plan into practice would require money and high-level researchers, and it is difficult for him to get either on the mainland.

He says he has never been granted funding from the central government and that all the funding he has received for his projects over the years has come from overseas.

'The authorities say the suicide rate has been reduced a lot and this issue is not their priority,' he says.

Phillips also plans to keep an eye on the implementation of the China Mental Health Law once it is passed. The law has been stuck in the draft stage for 26 years, but is now being considered by the National People's Congress Standing Committee.

He says that after so many years on the mainland he finds himself unsuited to life back in Canada, where daily talk about such things as what is on TV sounds alien to him.

'Even my French pronunciation is tinged with a Chinese accent nowadays,' Phillips says.

66%

The number of mainlanders who attempt suicide who do not have mental problems. In the West, only 10 per cent have no mental illness